Electronic System for Collecting and Automatically Populating Clinical Order Information

ABSTRACT

A graphical user interface for use on a computer coupled to an enterprise electronic medical records system for accepting order data including an order entry window corresponding to an identified order, the identified order including one or more parameters. The graphical user interface also including an expandable order editing box linked to the order entry window and responsive to identification of the order and adapted to accept an input from a user. The graphical user interface also including an order parameter manager coupled to the enterprise electronic medical records system that is adapted to populate at least one of the one or more order parameters based on information associated with a patient for whom the order is being placed. The graphical user interface further being adapted to display to the user the order and the at least one or more populated order parameters.

CROSS-REFERENCE TO RELATED APPLICATIONS

This patent is a continuation of U.S. application Ser. No. 11/286,742filed Nov. 22, 2005, which is a continuation of U.S. Pat. No. 6,983,423filed Dec. 10, 2001, which claims the benefit of U.S. Provisional PatentApplication No. 60/257,971, filed Dec. 22, 2000, the disclosures ofwhich are hereby incorporated by reference in their entirety for allpurposes.

BACKGROUND OF THE INVENTION

The ability for users to place a wide variety of orders quickly andaccurately is vital to the success of an electronic medical recordssystem designed for the acute care setting. If placing electronic ordersis too time consuming or involves too much repetitious entry of orderparameters, the electronic health care system loses usability andaccuracy, which can lower the efficiency of a healthcare enterprise andeven compromise the quality of patient care.

Physicians, nurses, clerks, and ancillary staff working in acute caresettings must often place a large number of complex orders at once. Thecare of each patient is likely to require many orders of a number ofdifferent types, including medications, blood tests, and nurseinterventions. In addition, acute care workflows lead many clinicians toenter orders for multiple patients at the same time after conductingpatient rounds, which further increases the need for efficient orderentry.

Orders in an acute care setting frequently require the specification ofcomplex order parameters, such as frequency, interval, count, dose, androute, which are a challenge to communicate effectively in any orderingsystem, even a traditional paper ordering system. A nurse interventionorder may tell the nurse to check a patient's vital signs every hour for24 hours, then to take vitals four times per day for the next two days.Or it may ask that blood levels be tested every two hours until normallevels are reached and then every four hours up to a count of eighttimes. Electronic ordering systems for both ambulatory and acute caresettings have usually relied on the selection of an order from adatabase, followed by text entry of order parameters on a number ofwindows for each order before it is filed. In the acute care setting,such entry methods are likely to inhibit regular use of the orderingsystem or even any use at all, because staff find it too cumbersome toenter order parameters by hand on more than one window for every order.

While these order parameters may be very complex, the likely parametervalues for a given order generally belong to a predictable set. In fewcases does care require the entry of an order “from scratch” withparameters that cannot be anticipated. A physician is likely to placemany orders for patient vitals with similar frequencies at similarintervals. Therefore, text entry of electronic orders not only creates arepetitious workflow that needlessly adds time to the task of orderentry, but it fails to take advantage of the ease with which manyparameters can be selected from a set of pre-defined common values forthe order. In addition, text entry of order parameters increases thelikelihood of written error or miscommunication of what are in factroutinely selected values.

BRIEF SUMMARY OF THE INVENTION

According to a preferred embodiment of the invention, a graphical userinterface for use on a client computer coupled to an enterpriseelectronic medical records system for accepting order data is described.The graphical user interface includes an order type navigation bar,wherein order types are selectable from the order type navigation bar.The interface further includes an order entry window, linked to theorder type navigation bar, the order entry window responsive to aselected order type to display an order list of the selected order type.The interface yet further includes an expandable order editing boxlinked to the order entry window and responsive to selection of an orderfrom the order list to provide an order data editing box and an orderdata summary, the order data summary responsive to the selected orderfrom the order list.

According to another preferred embodiment of the invention, a method ofentering order information in a health care setting is described. Themethod includes the steps of accessing a data repository holding aplurality of possible order templates and a plurality of possible orderparameters available for an order, the order corresponding to the ordertransmittal. The method further includes generating a predictive set oforder templates from the plurality of possible order templates availablein the database, the predictive set of order templates beingsubstantially smaller than the plurality of possible order templates.The method yet further includes displaying a list of the predictive setof order templates on a graphical user interface and generating, for anorder template selected from the predictive set of order templates, apredictive set of order parameters from the plurality of possible orderparameters available in the database, the predictive set of orderparameters being substantially smaller than the plurality of possibleorder parameters. The method yet further includes modifying thepredictive set of order parameters to include at least one orderparameter derived from a record, the record being at least one of apatient record, a user profile, or a preference list and displaying themodified predictive set of order parameters on the graphical userinterface.

These particular features and advantages may apply to only someembodiments falling within the claims and thus do not define the scopeof the invention.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a graphical representation of a user interface in accordancewith a preferred embodiment of the invention illustrating interaction ofthe user interface with an electronic medical records (EMR) system.

FIG. 2 is a flow chart representation of an order entry workflow inaccordance with a preferred embodiment of the invention.

FIG. 3 is a flow chart representation of an order editing workflow inaccordance with a preferred embodiment of the invention.

FIG. 4 is a flow chart representation of another order editing workflowin accordance with a preferred embodiment of the invention.

FIG. 5 is a flow chart representation of another order editing workflowin accordance with a preferred embodiment of the invention.

FIG. 6 is a flow chart representation of another order editing workflowin accordance with a preferred embodiment of the invention.

FIG. 7 is a flow chart representation of another order editing workflowin accordance with a preferred embodiment of the invention.

DETAILED DESCRIPTION OF THE INVENTION

According to a preferred embodiment of the invention an interactive,graphical user interface presents user-specific lists of orders groupedinto types. When the user clicks an order sentence corresponding to thatorder appears. The user then clicks on the sentence to open an expandedorder editing box accompanied by a set of buttons and selection listsencompassing the parameters that must be defined for the order and themost common values for those parameters. To facilitate quick orderentry, the entire order entry process can be conducted with the mouse oranother pointing device, by selecting the order via a check box andspecifying all parameters by clicking buttons and selection lists.

The list of orders, order parameters, and default values can beconfigured by the users of the enterprise employing apparatus andmethods according to preferred embodiments of the invention, in order toreduce the time spent searching for options that are routinely used.Orders can also be grouped and order parameters can be populated bydefault information on the basis of user preference and history of carefor the patient. For example, a user may create order sets containingthe orders commonly placed when admitting a patient with a respiratorycondition. Alternatively, if a patient has been diagnosed with aspecific condition in the past, a system defined order set may appearfor the user containing defaults recommended for a patient with thecondition.

Order parameters include priority, frequency, dose, route, interval,start and end dates, and count, but they can be extended to includeother parameters users want to define for orders. In addition, eachorder can be configured to contain “condition” buttons, accommodatinghighly complex order parameters, such as one frequency for an orderlasting a specified interval, followed by a different frequency, whichlasts for a successive interval. Other condition options can allow usersto specify a sequence of orders or to alternate between two orders forspecified intervals. As with the order parameters, the condition optionsare extendible to meet user needs.

As the user selects options for order parameters, the parameter valuescurrently selected appear in a dynamically generated summary sentence atthe top of the order editing box. The summary sentence serves severalpurposes. It clarifies the selections the user has made and shows howthe order parameters will appear to the staff member who receives theorder. The summary sentence also helps the user keep track of the oftencomplex succession of intervals or conditions selected for the order, inorder to reduce the potential for medical error and ensure that theorder is properly specified and communicated.

In addition, a variety of decision support alerts can be associated withorders, warning users of factors in patient care that may affect thedecision to place the order, such as duplicate orders for the patient ordangerous medication interactions. These decision support options can beconfigured to locate any important information stored in theenterprise's database repository and present it to the user when theorder is selected. Thus, decision support for orders is highlyconfigurable and can provide the user with reports containing procedureinstructions, previous order values recorded for the patient, access toclinical reference and enterprise-defined procedure instructions andguidelines for the order, or any other stored information the enterprisewants to present to a user selecting the order.

The user can select as many orders as desired for the patient in onesession of use from the single “Order Composer” Window provided. Allediting of order parameters can be performed within an expanded orderediting box, which appears for each selected order. Only one orderediting box is expanded at a time, and when the user clicks anotherorder, the current order's box collapses, saving all the current valuesand displaying them beside the order in the form of the summarysentence. The user can return to edit any order at any time until theorders for the session are filed. When the desired orders and parametershave been selected, all the order information assembled can be filedsimultaneously with a single button click into the database and undergoorder transmittal processing. This order transmittal processing can beconfigured to send order information in a variety of formats to avariety of destinations, including interfaces, faxes, printers, and acomprehensive messaging system that links staff mail boxes, staffworklists, networked terminals, and enterprise mail box pools.

The invention may be implemented as part of an enterprise-wideintegrated electronic medical records (EMR) system that is designed toserve large-scale health care enterprises. Therefore, the invention haspractical use with the extensive data repositories, network ofworkstation terminals, and numerous concurrent users employed by suchlarge enterprises.

FIG. 1 represents an overview of the dynamic interaction between thestructures of the invention's database repository and the features thesestructures support in the enterprise medical record (EMR) system 100including an EMR graphical user interface 110. The EMR System 100 may beimplemented using a suitable computing platform including processing,memory and input/output capability. The EMR system 100 may be astandalone system, may be implemented as part of a larger enterprisehealthcare information management system, or as part of a network ofdevices providing information management services to the healthcareenterprise. The EMR System 100 may include two elements of an ordercomposer apparatus 102 according to a preferred embodiment of theinvention. These two elements are the order display engine 112 and theorder parameter manager 114. The order display engine 112 and the orderparameter manager 114 bring together and communicate information storedin various records of the data repository 118 that are relevant toplacing clinical orders. These records include the patient record 120,the decision support settings 122, the user security record 124, theorder transmittal instructions 126, the order parameters and defaultvalues 128, the user profile and preference lists 130, and the orderrecord 132. The order display engine 112 and the order parameter manager114 present and update the correct information to appear when a specificuser employs the EMR graphical user interface 110. The order displayengine 112 determines the orders that are listed for each order typebased on the user profile and preference lists. It also finds the orderparameters to include for each listed order and any default values.Decision support for the listed orders, such as alerts or procedureinstructions are also loaded, along with the order transmittalprocedures for the session of use. The order display engine 112 alsoconsults the user security record 124 to determine whether the user canfile orders or if a cosign or authorization is needed. The orderparameter manager 114 stores parameters 146 as the user enters themprior to the filing of orders. These parameters 146 are used todynamically create the summary sentence 148 for the order.

The EMR graphical user interface 110 presents the user with the orderentry activity 134, which is one activity within the larger EMR system110. The EMR graphical user interface 110 is generated by the orderdisplay engine 112, and is displayed to the user via a suitable displaydevice or devices (not shown). The order entry activity 134 contains: anactivity list bar 145 listing possible activities that may be undertakenin connection with the current patient, a patient information header 147that displays identifying and other patient related information aboutthe current patient and an order type navigation bar 136, displaying thelist of various order types 138. When the user clicks an order type 138,the list of orders 140 belonging to that order type 138 is displayed inthe order composer window 142. When a user clicks an order from the list140, a sentence statement of the order appears. The user then clicks onthe sentence to open an expanded order editing box 144 in the ordercomposer window 142, allowing the user to define all order parameters146 necessary for the order, as defined by the enterprise employing theinvention. The user selects an order from a user-specific list causingthe order sentence to appear. By clicking on the sentence, the user thencauses the expanded order editing box 144 to appear. Decision supportinformation 122, such as procedure instructions, order alternatives, andformulary options alert the user to import information when the order isselected. When the user has selected all desired orders and parameters,a single button click files the order information assembled in the ordercomposer window 142. The order parameters 146 the user selects for theorder appear in the dynamically generated summary sentence 148 at thetop of the order editing box 144. All selected orders can be filedsimultaneously by clicking the file orders button (not depicted) in theorder entry activity toolbar 150.

FIG. 2 depicts an order entry workflow 200 in which a user logs into theEMR system 100 supporting the order composer 102, selects three ordersof different order types and files them simultaneously. From the start202, to open the order composer 102, the user must enter a valid loginand password 204, and at 206, the EMR system 100 determines theauthorized activities for the user and displays options in the activitytool bar 150. The EMR system 100 must also recognize the user asauthorized to place electronic orders 208 and 210. Once the user opens212 the order entry activity 134, the order entry activity 134 displays214 the available order types 138 to the user in the order typenavigation bar 136. Order types can follow clinical categories, but theycan also represent order sets based on user preference or enterpriseguidelines. As illustrated in FIG. 2, the user proceeds 216 to selectOrder Type A from the order type navigation bar 136. The user profileengine 130 then determines 218 what orders of Type A appear for thecurrent user. When the user selects 220 the desired order from the TypeA list and clicks on the displayed order sentence, two things happen.First, any decision support alerts 122 relevant to the order or itsinteraction with patient data are triggered and presented 220 to theuser. Second, the expanded order editing box 144 appears 224 in the samewindow in which the order list was displayed, and decision supportalerts may also appear in the expanded order editing box 144. Here, theuser edits all parameters 146 for the order. The user repeats for OrderType B (228-238) and Order Type C (240-250) the process of selecting anorder type and selecting and editing an order. There could be as manymore order types to choose from as the enterprise provides and the usercreates. Enterprises can add new order types containing any set oforders at any time, and users can define order types that appear onlywhen they use the order entry activity 134. After selecting all desiredorders, the user clicks 252 the file orders button and simultaneouslyfiles all selected orders, sending them through enterprise-defined ordertransmittal processes 254.

FIG. 3 shows the process 300 of editing 226 a sample Vitals order, whichin this scenario was listed in Order Type A selected at step 224 of FIG.2. The parameters 146 the user sets for the Vitals order are priority302, interval 304, and count 306. For each parameter, the user can clicka pre-defined button, e.g., 308-312 for priority, 318-324 for intervaland 330-334 for count, to select a common value for the parameter. Inthe example illustrated in FIG. 3, the user selects 314, 326 and 336,respectively a High priority 308, a Q4 interval 318, and a count of 4330. When appropriate, the user can also choose from the more extensiveselection list options provided for the interval and count parameters,e.g., buttons 324 and 334. Each time the user sets a value for aparameter 146, the value appears, 316, 328 and 338, in text form as partof the summary sentence 148 at the top of the order editing box 144. Theuser can change the value selected for a parameter 146 as many times asdesired. When the user is done editing the order, the user clicks 340 onthe next order to be edited, causing the Vitals order's editing box tocollapse 342 and the next order sentence to appear. Clicking on theorder sentence causes the editing box for the next order to expand. Theparameter values set for the Vitals order appear in the form of thesummary sentence 148 next to the order where it appears in the list ofType A orders.

FIG. 4 shows the process 400 of editing 238 a sample Medication order,which in this scenario was listed in Order Type B 236. The parameters146 the user sets are dose 402, route 404, and frequency 406. For eachparameter 146, the user can click a pre-defined button, e.g., 408-412for dose, 418-424 for route and 430-436 for frequency, to select acommon value. In the example illustrated in FIG. 4, the user selects414, 426 and 438, respectively 500 mg for the dose 408, a route of IV424, and a frequency of BID (meaning twice per day) 432. The user canalso choose from the more extensive selection list options, e.g.,buttons 412 and 436, provided for the dose and frequency parameters.Each time the user sets a value for a parameter 146, the value appears,416, 428 and 440, in text form as part of the summary sentence 148 atthe top of the order editing box 144. The user can change the valueselected for a parameter as many times as desired. When the user is doneediting the order, the user clicks 442 on the next order to be edited,causing the Medication order's editing box to collapse 444 and the ordersentence for the next order to appear. Clicking on the order sentencecauses the editing box for the next order to expand. The parametervalues set for the Medication order appear in the form of the summarysentence 148 next to the order where it appears in the list of Type Borders.

FIG. 5 shows a process 500 for editing 238 another sample Medicationorder from Order Type B, immediately after editing the Medication orderin FIG. 4. The parameters 146 the user sets are dose 502 and condition504. For each parameter 146, the user can click a pre-defined button,e.g., 506-512 for dose and 518-522 for condition, to select a commonvalue. In the example illustrated in FIG. 5, the user selects 514 and524, respectively 250 mg for the dose 506 and an If condition 518. Theuser can also select an option from the more extensive selection listoptions 512 provided for the dose parameter. When the user selects 524,528 or 532 a condition 504, the user can choose from an additionalselection list of pre-defined text options 526, 530 and 534,respectively in order to complete a sentence explaining thecircumstances under which the order should be administered ordiscontinued. This condition 504 appears 536 along with the otherparameter values 516 set for the order in the summary sentence 148 atthe top of the order editing box 144. For example, if the user clicksthe If condition 518 and chooses patient experiences headache from theselection list 526, the summary sentence 148 would read if patientexperiences headache, 500 mg Medication. The user can change the valueselected for a parameter 146 as many times as desired. When the user isdone editing the order, the user clicks 538 on the next order to beedited, causing the Medication order's editing box to collapse 540 andthe order sentence for the next order to appear. Clicking on the ordersentence causes the editing box for the next order to expand. Theparameter values set for the Medication order appear in the form of thesummary sentence 148 next to the order where it appears in the list ofType B orders.

FIG. 6 shows the process 600 of editing a sample X-Ray order, which inthis scenario was listed in Order Type C. The parameters 146 the usersets are when 602 and condition 604. For each parameter, the user canclick a pre-defined button, e.g., 606-610 for when and 616-618 forcondition. In the example illustrated in FIG. 6, the user selects 612and 620, respectively Today AM for when 606 and a Before condition 616.The user can also choose from the more extensive selection list options610 provided for the when parameter. Once the user selects a condition604, the user can choose 622 and 626 from an additional selection listof pre-defined text options in order to complete a summary sentence 148explaining the sequence in which orders should be administered. Thiscondition 604 appears 614 and 628 along with the other parameter valuesset for the order in the summary sentence 148 at the top of the orderediting box 144. For example, if the user clicks the Before conditionbutton and chooses other orders from the selection list, the summarysentence would read X-Ray before other orders. The user can change thevalue selected for a parameter 146 as many times as desired. When theuser is done editing the order, the user can click 630 on the next orderto be edited, causing the X-Ray order's editing box to collapse 632 andthe next order sentence to appear. Clicking on the order sentence causesthe editing box for the next order to expand. The parameter values setfor the X-Ray order appear in the form of the summary sentence (notdepicted) next to the order where it appears in the list of Type Corders.

FIG. 7 exhibits the variety of decision support alerts 222, 234 and 246that may be triggered when a user selects an order to edit. The decisionsupport alerts may be displayed directly within the order editing box,or the decision support alerts may be displayed at an appropriatelocation with the EMR graphic user interface 110. Any, all, or none ofthe alerts shown may appear when a user selects the order, depending onhow the enterprise employing the invention has configured the decisionsupport settings 122 and the order record 132. Alerts warnings state tothe user the type of alert that has been triggered 702-714 and provideaccess 716-726 to a report or other enterprise-defined informationdetailing the reason for the alert and/or suggesting alternative orders.There are six alerts depicted as primary examples:

The procedure instructions provide a link to special instructions theenterprise wants a user placing the order to see, 702.

The medication interactions alert the ordering user that the medicationorder selected may interact dangerously with another medication orderedfor the patient or with one of the patient's recorded allergies, 704.

The previous questions warning presents a report to the user displayingprevious results the patient has received for the same order, 708.

The duplicate check warns the user if the same order has been placed forthe patient within a facility-defined time interval, e.g. 24 hours,indicating that it may be a duplication of the same order, 710.

The required orders alert informs the user that there are questions thatmust be answered about the order before it can be placed. The user canclick a button to view and edit the questions, 712.

The clinical reference and guidelines alert the user that the order maybe part of an enterprise protocol that provides specific instructions ona treatment program or that the order is counter-indicated by enterpriseprotocols. The user can view the guidelines or reference in order todecide whether the order should be placed, 714.

These decision support options can be configured to locate any importantinformation the enterprise employing the invention has stored in itsdatabase repository and present it to the user when the order isselected. The user may determine whether the order is to be placed 728and if so continue editing the selected order 730 or if not select adifferent order 732.

The invention has been described in terms of several preferredembodiments. It will be appreciated that the invention may otherwise beembodied without departing from the fair scope of the invention definedby the following claims.

1. A computer-implemented graphical user interface for use on a clientcomputer coupled to an enterprise electronic medical records system foraccepting order data, the graphical user interface comprising: an ordertype navigation bar, wherein order types are selectable from the ordertype navigation bar; an order entry window, linked to the order typenavigation bar, the order entry window responsive to a selected ordertype to display an order list of the selected order type; an expandableorder editing box linked to the order entry window and responsive toselection of an order from the order list to provide an order dataediting box and an order data summary, the order data summary responsiveto the selected order from the order list.
 2. A computer-implementedmethod of entering order information in a health care setting, themethod comprising: accessing a data repository holding a plurality ofpossible order templates and a plurality of possible order parametersavailable for an order, the order corresponding to the ordertransmittal; generating a predictive set of order templates from theplurality of possible order templates available in the database, thepredictive set of order templates being substantially smaller than theplurality of possible order templates; displaying a list of thepredictive set of order templates on a graphical user interface;generating, for an order template selected from the predictive set oforder templates, a predictive set of order parameters from the pluralityof possible order parameters available in the database, the predictiveset of order parameters being substantially smaller than the pluralityof possible order parameters; modifying the predictive set of orderparameters to include at least one order parameter derived from arecord, the record being at least one of a patient record, a userprofile, or a preference list; and displaying the modified predictiveset of order parameters on the graphical user interface.
 3. The methodof claim 2, wherein the predictive set of order templates and thepredictive set of order parameters are selected to be the mostappropriate for a patient.
 4. The method of claim 2, further comprisinggenerating an alert based on information derived from one of the patientrecord or the selected order template.
 5. The method of claim 2, furthercomprising dynamically displaying an order data summary within a displaywindow on the graphical user interface, the order data summaryresponsive to at least the selected order template and the at least oneorder parameter derived from the record.